Pathological Gambling: A Present Problem From the Past

Pathological gambling and substance dependence share many features, including similarities in diagnostic features, clinical courses and high rates of comorbidity. (For additional details, please see Psychiatric Times October 2001-Ed.) Given these similarities, it has been proposed that pathological gambling may be conceptualized as an addiction without the drug. In order to gain a better understanding of the etiology and pathophysiology of pathological gambling and its relationship to drug dependence, rigorous study needs to be applied to pathological gambling as it has been to drug dependence.

Craving represents a highly clinically relevant internal state as it often immediately precedes engagement in a self-destructive addictive behavior and is consequently a target of both behavioral and pharmacological treatments. A craving or appetitive urge state is also common to both drug dependence and pathological gambling.

Wexler and colleagues (2001) recently conducted a functional magnetic resonance imaging-based study of cocaine cravings in individuals with cocaine dependence. (For additional details, please see Psychiatric Times October 2001-Ed.) The protocol involved the exposure of healthy controls and cocaine-dependent subjects to three different types of videotaped scenarios (cocaine-related, happy and sad) during brain imaging tests. The paradigm allowed for the identification of brain activities that were specific to viewing of cocaine-related scenarios in cocaine-dependent subjects; that is, the pattern of activity was not seen in cocaine-dependent subjects viewing happy or sad scenarios or control subjects viewing the drug- or emotion-related videos. The results of the study demonstrated differences in limbic and frontal brain regions during drug-cue exposure in cocaine-dependent subjects and suggested the existence of more generalized dysregulation in neural circuits thought to mediate affective responses.

We have currently modified the paradigm used by Wexler and colleagues in order to study the responses of subjects with pathological gambling disorders to emotional and gambling cues. Comparison of similarities and differences in the neural responses of individuals with pathological gambling disorders to patients with a drug dependence will help not only to better define the underlying neurobiology of pathological gambling, but also to clarify its relationship to drug use disorders. For many years, relatively few investigations into the neurobiology of pathological gambling have been performed. Pathological gambling represents a significant public health concern. An improved understanding of the basic biological processes contributing to the disorder will likely facilitate advances in the prevention and treatment efforts related to not only pathological gambling, but also for other disorders characterized by features of impaired impulse control.